WO2012073944A1 - Dispositif de ligature tissulaire - Google Patents

Dispositif de ligature tissulaire Download PDF

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Publication number
WO2012073944A1
WO2012073944A1 PCT/JP2011/077498 JP2011077498W WO2012073944A1 WO 2012073944 A1 WO2012073944 A1 WO 2012073944A1 JP 2011077498 W JP2011077498 W JP 2011077498W WO 2012073944 A1 WO2012073944 A1 WO 2012073944A1
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WO
WIPO (PCT)
Prior art keywords
thread
suture
fixing member
ligation device
tissue ligation
Prior art date
Application number
PCT/JP2011/077498
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English (en)
Japanese (ja)
Inventor
藤崎　健
卓未 磯田
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Publication of WO2012073944A1 publication Critical patent/WO2012073944A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0414—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having a suture-receiving opening, e.g. lateral opening
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417—T-fasteners

Definitions

  • the present invention relates to a tissue ligation device, and more particularly to a tissue ligation device including a suture thread and a thread fastening member.
  • a particularly difficult operation is an operation of tying a suture to form a knot. If the knot is loosened, the sutures and ligatures may be released, causing serious complications. Therefore, depending on the procedure, many knots may be formed, and the difficulty level further increases.
  • This medical suturing device includes a suture body in which a suture is connected to a suture fix member.
  • the thread fixing member has a housing portion capable of housing a part of the suture thread.
  • the suture thread may come out of the accommodation portion when the suture is drawn.
  • the suture thread must be passed through the receiving portion once again.
  • a suture body used in an actual procedure may have a very small size, for example, a thread fixing member having a dimension of 1 millimeter (mm) square or less and a suture diameter of 0.2 to 0.3 mm or less. .
  • mm millimeter
  • the present invention has been made in view of the above circumstances, and an object thereof is to provide a tissue ligation device capable of forming a knot more stably.
  • the tissue ligation device is a tissue ligation device to which a suture is attached and used for tissue ligation, and is a container that is attached to the suture and is capable of inserting a part of the suture. And a retaining member for restraining the suture thread inserted into the accommodating portion from coming out of the accommodating portion.
  • the retaining portion is formed on the thread retaining member.
  • the retaining portion may include a protruding portion that protrudes into the housing portion.
  • the retaining portion may include a constricted portion that makes the size of the accommodating portion smaller than the size of other portions in a state viewed from at least one direction.
  • the housing portion may be configured to bend in a state viewed from at least one direction, and the housing portion may function as the retaining portion in the bent state.
  • the tissue ligation device according to the third aspect of the present invention further includes a suture thread attached to the thread stopper.
  • the tissue ligation device further includes a suture needle attached to one end of the suture.
  • the tissue ligation device of the present invention can form a knot more stably.
  • tissue ligation device of 1st embodiment of this invention It is an expansion perspective view which shows the thread
  • FIG. 1 These are front views which show the thread fixing member in the modification of the tissue ligation device of 1st embodiment of this invention. It is a front view which shows the thread fixing member in the modification of the tissue ligation device of 1st embodiment of this invention. These are front views which show the thread fixing member in the modification of the tissue ligation device of 1st embodiment of this invention. It is a front view which shows the thread fixing member in the modification of the tissue ligation device of 1st embodiment of this invention. It is a front view which shows the thread fixing member in the modification of the tissue ligation device of 1st embodiment of this invention. It is a figure which shows the state by which the thread fixing member of 1st embodiment of this invention was deform
  • FIG. 1 is a diagram showing a tissue ligating device (hereinafter referred to as “ligating device”) 1 according to the present embodiment.
  • the ligating device 1 includes a suture thread 10, a suture needle 20 attached to the first end portion 10 ⁇ / b> A of the suture thread 10, and a thread fixing member 30 attached to the second end portion 10 ⁇ / b> B of the suture thread 10. ing.
  • the suture thread 10 is preferably a member that is preferably made of resin or metal and has a certain degree of elasticity to maintain a straight state, but may be a member that does not have elasticity.
  • the suture thread 10 is formed of a resin material, it is preferably formed of a bioabsorbable resin from the viewpoint of eliminating the need for thread removal (in this case, the thread fixing member is also formed of an absorbent resin).
  • the suture thread 10 may be formed of a non-absorbable resin.
  • a monofilament (single wire) member and a multifilament (double wire) member are properly used in consideration of applications and the like.
  • a monofilament member a single wire composed of one material, a member composed of a two-layer structure of a core formed from a material having a high tensile strength and a clad formed from a material having good weldability, etc.
  • Multi-layer members can also be used.
  • the multifilament member either a member formed by knitting a plurality of strands or a member formed by twisting can be used.
  • the member of a multifilament may be formed combining the strand formed from a several different material.
  • suturing needle 20 various known suturing needles can be used.
  • a straight suturing needle, a curved suturing needle, a suturing needle in which only the distal end portion is curved and the other part is formed in a straight line can be appropriately selected in consideration of the suturing site and the like. it can.
  • the connection mode between the suture thread 10 and the suture needle 20 is not particularly limited.
  • the suture thread 10 and the suture needle 20 may be in any form that can maintain a connected state with respect to the amount of force acting on the connection site between the knot forming operation and the operation of passing the suture thread through the tissue, which will be described later.
  • a method such as adhesion, welding, or a method in which the end of the suture thread 10 is passed through a hole formed in the end of the suture needle.
  • FIG. 2 is an enlarged perspective view of the thread fixing member 30.
  • the thread stopper 30 is made of metal, resin, or the like.
  • the suture fix member 30 includes a connection portion 31 to which the second end portion 10B of the suture thread 10 is connected and an arm portion 32 extending from the connection portion 31.
  • the connecting portion 31 is formed in a substantially rectangular parallelepiped shape, and has an insertion port 31A into which the second end portion 10B of the suture thread 10 is inserted.
  • the second end 10B is inserted into the insertion port 31A.
  • the suture 10 and the thread fixing member 30 are connected and attached to the second end portion 10B by bonding or the like.
  • the arm portion 32 includes a first arm portion 32A extending from the connection portion 31 and a second arm portion 32B extending from the first arm portion 32A and being folded back to the connection portion side.
  • the first arm portion 32A has a direction in which the insertion port 31A extends (hereinafter referred to as this direction) from above one side 31B in the front view of the yarn fixing member 30 (when the yarn fixing member 30 is viewed from the surface where the insertion port 31A opens). It is referred to as the “thickness direction” of the thread fixing member 30) and extends linearly in a direction substantially perpendicular to the thread fixing member 30.
  • the two second arm portions 32B branch from the end portion of the first arm portion 32A to both sides in the width direction of the first arm portion 32A, and are bent 180 degrees in a hairpin shape in a curved manner toward the connection portion 31. It extends.
  • the accommodating portions 33 into which a part of the suture thread 10 is inserted are formed on both sides of the first arm portion 32 ⁇ / b> A in the width direction over the thickness direction of the suture fix member 30.
  • the two accommodating portions 33 extend substantially parallel to the first arm portion 32 ⁇ / b> A in the front view of the thread fixing member 30 due to the shape of the arm portion 32.
  • the first arm portion 32A and the second arm portion 32B have substantially the same width dimension. This width dimension is shorter than one side 31B of the connection part 31 from which the first arm part 32A extends.
  • the first arm portion 32A extends from an intermediate portion in the longitudinal direction of one side 31B. Therefore, in the connecting portion 31, a region belonging to both end portions in the longitudinal direction of the side 31 ⁇ / b> B is formed as a protruding portion 34 that protrudes into the accommodating portion 33.
  • the protrusion 34 has a function as a retaining portion that prevents the suture thread 10 inserted into the accommodating portion 33 from being detached from the thread retaining member 30 in the knot forming operation.
  • the size of the thread fixing member 30 is not particularly limited, and may be set as appropriate in consideration of a suture site and the like.
  • the dimension of the thread fixing member 30 is set to a small size such as 1 mm square, for example, laser processing, wire electric discharge processing, and cutting processing are performed on a rectangular parallelepiped member that is formed of, for example, stainless steel.
  • the yarn fixing member 30 can be preferably manufactured.
  • the surgeon introduces the ligation device 1 in the vicinity of a treatment target tissue (hereinafter referred to as “target tissue”).
  • target tissue a treatment target tissue
  • an applicator having a sheath as described in Patent Document 1 may be used.
  • the operator grasps the suture needle 20 with forceps or the like and places it on the target tissue T1 around the wound W as shown in FIG. Further, as shown in FIG. 4, the surgeon hangs the suture needle 20 on the target tissue T2 facing the target tissue T1 across the wound W, and passes the suture 10 into the target tissue so that the wound W can be sutured.
  • the surgeon grasps the suture 10 or the suture needle 20 and passes (inserts) a part of the suture 10 into the accommodation portion 33 of the suture fix member 30.
  • the suture thread 10 may be inserted into any of the two accommodation portions 33.
  • the thread fixing member 30 connected to the second end portion 10B is moved to the target tissue T1. Closely pressed. Further, the suture thread 10 passing through the target tissue is drawn and drawn so that the target tissue T1 and the target tissue T2 approach each other.
  • the suture thread 10 may move in a direction in which the suture thread 10 is detached (disengaged) from the accommodating portion 33 due to its elasticity or when an external force is applied.
  • the movement of the suture thread 10 as described above is hindered by the protruding portion 34 protruding into the accommodating portion 33 as shown in FIG. 7B. Therefore, the suture thread 10 is preferably prevented from coming off from the accommodation portion 33 and coming off from the thread fixing member 30. That is, in the ligating device, the suture 10 can be similarly prevented from coming out of the accommodating portion regardless of whether the suture has elasticity or not.
  • the suture thread 10 When the suture thread 10 is passed through the housing portion 33, the suture thread 10 passes through the side of the connecting portion 31 from the outside in the width direction of the second arm portion 32B as shown in FIG. 7A. It is inserted inside. For this reason, the protruding portion 34 hardly inhibits the insertion operation of passing the suture thread 10 through the accommodating portion 33.
  • the operator sandwiches the first arm part 32A and the second arm part 32B with forceps or the like, and deforms the second arm part 32B as shown in FIG.
  • the stop member 30 is fixed.
  • the portion where the suture thread 10 and the thread fixing member 30 are fixed has a function as a knot Kn of the suture thread, and the target tissue T1 and the target tissue T2 block the wound portion W as shown in FIG. Are sutured.
  • the knot forming operation using the ligating device 1 is completed.
  • pulling the suture thread 10 and applying tension makes it possible to sew more reliably.
  • the operator removes the excess suture 10 and collects the excised suture 10 and the suture needle 20 outside the body cavity.
  • the wound portion W is large, the surgeon continuously introduces a new ligation device 1 and repeats the above knot forming operation. Then, the surgeon finishes the procedure when the wound W is completely sutured.
  • the portion where the suture thread 10 and the thread fixing member 30 are fixed is actually different from a knot formed by a method such as a male knot or a female knot.
  • the part has a function similar to a general knot formed in a surgical procedure for holding the suture 10 so that the suture 10 hung on the target tissue is not loosened. Therefore, in this invention, the said site
  • the thread fixing member 30 is formed with a protruding portion 34 that protrudes into the accommodating portion 33 through which the suture thread 10 is inserted. For this reason, even if the suture thread 10 moves in a direction in which the suture thread 10 is pulled out of the housing part 33 due to elasticity or the like, the protrusion part 34 can suitably prevent the suture thread 10 from coming out of the housing part 33. That is, the protrusion 34 functions as a retaining portion. Therefore, the knot forming operation can be performed easily and smoothly, and the knot can be formed stably.
  • the accommodating portion 33 is formed over the thickness direction of the yarn fixing member 30. Therefore, the arm portion 32 is sufficiently deformed only by applying a force from both sides in the width direction of the arm portion 32, so that the thread fixing member 30 and the suture thread 10 can be easily fixed by a simple operation. Note that in a technique using an endoscope, a laparoscope, or the like, a space in which forceps and the like can be moved is limited. Therefore, the above-described effect produced by the ligation device of the present invention can be obtained more significantly.
  • the thread fixing member has one first arm portion 32A and two second arm portions 32B, a part of the connection portion 31 is formed as a projection portion 34, and the appearance is formed in a substantially bowl shape.
  • the thread stopper 30 has been described.
  • the shape of the thread fixing member can be variously changed.
  • only one first arm portion 32A may be provided as in the modification shown in FIG. 10A.
  • the thread fixing member can be easily reduced in size and can be adapted to a procedure in a minute region.
  • transforms the 1st arm part 32A at the time of knot formation decreases, and deformation
  • the protruding portion may be formed separately from a part of the connecting portion.
  • a plurality of protrusions 36 may be formed on the side surface of the first arm portion 32A (or the side surface of the second arm portion 32B) that forms the inner surface of the housing portion 33.
  • one protruding portion 37 protruding into each accommodating portion 33 may be formed separately from the connecting portion 31.
  • the protruding portion is formed so as to have a convex portion in the direction away from the opening 33 ⁇ / b> A into which the suture thread 10 is introduced, like the protruding portion 36, the suture thread 10 is placed in the receiving portion 33.
  • the thread fixing member of the present embodiment is not limited to the configuration having the above-described substantially hooked shape.
  • 11A to 11I show other modified examples of the thread fixing member 30.
  • 11A has a second arm portion 32B that is longer than the first arm portion 32A.
  • a wider area of the connecting portion 31 functions as a protruding portion.
  • the second arm portion 32B functions as a guide when the suture thread 10 is passed through the housing portion, the knot forming operation can be performed more easily.
  • the second arm portion 32B is folded back at a steep angle so that the accommodating portion 33 has a corner portion 33A.
  • the protrusion 38 is provided at the end of the second arm portion 32B.
  • the behavior of the suture during the knot forming operation is stabilized by pulling and pulling the suture 10 inserted in the accommodating portion 33 in the direction in which the suture 10 is pressed against the corner portion 33A.
  • the connection part 40 may be formed in the width dimension equivalent to an arm part like the thread fixing member 30D shown to FIG. 11D.
  • the first arm portion 32 ⁇ / b> A has a function as a guide for the suture thread 10.
  • the accommodating portion 33 is formed in a substantially circular shape when viewed from the front.
  • the accommodating portion is relatively large with respect to the thread fixing member, there is an advantage that the accommodating portion can be easily visually recognized.
  • the boundary between the first arm portion and the second arm portion is not clear, and a region having a predetermined length including the tip of the arm portion 32 has a function as the protruding portion 39.
  • a protruding portion 41 may be provided separately from the arm portion 32 as in a thread fixing member 30F shown in FIG. 11F.
  • an opening for allowing the suture thread to pass through the accommodating portion is formed at a position farther from the insertion port 31A than the thread fixing member 30E.
  • the thread stopper members 30G, 30H, and 30I shown in FIGS. 11G to 11I are not folded back and are not provided with the second arm. Also in this case, the protrusions 44 ⁇ / b> A, 44 ⁇ / b> B, and 44 ⁇ / b> C are respectively provided in the accommodating portion 43 formed between the two arm portions 42, thereby suitably preventing the suture thread 10 from coming out of the accommodating portion 43. Can do. In addition, in any of the thread stoppers 30G, 30H, and 30I, a knot can be formed by gripping and crushing the entire thread stopper without being aiming at the arm portion with forceps. can do. When the thread fixing member is formed in the shape of the thread retaining member 30G, as shown in FIG.
  • the notch 42A may be formed so that the width of the arm portion 42 is narrowed.
  • the thread fixing member is suitably deformed. As a result, the suture thread and the thread fixing member can be more reliably fixed.
  • the ligating device 51 of the present embodiment is different from the above-described ligating device 1 in the aspect of the retaining portion in the thread securing member.
  • components that are the same as those already described are assigned the same reference numerals and redundant description is omitted.
  • FIG. 13 is an enlarged view showing the thread fixing member 52 and its periphery of the ligating device 51.
  • One arm portion 54 extends from the connection portion 53.
  • the arm portion 54 extends while curving into a substantially oval shape in front view of the thread fixing member 52.
  • An accommodating portion 55 formed in an approximately oval shape is formed inside the curved arm portion 54.
  • An end portion of the curved arm portion 54 extends toward the connection portion 53, and forms a constricted portion 54A that narrows an opening 55A through which the suture thread 10 is accommodated in the substantially oval accommodating portion 55.
  • the narrowed portion 54A functions as a retaining portion.
  • the opening 55A that is a part of the accommodating portion 55 is narrowed by the narrowed portion 54A in the front view of the yarn fixing member 52. Therefore, even if the suture thread 10 moves in the accommodating portion 55 due to elasticity or the like, the suture thread 10 hits the arm portion 54 including the narrowed portion 54A as shown by arrows A1 and A2 in FIG. The probability of passing through the housing portion 55 is reduced. Therefore, similarly to the ligating device 1, it is possible to suitably prevent the suture thread 10 from being detached from the accommodating portion 55 during the knot forming operation.
  • the surfaces of the connecting portion 53 and the arm portion 54 formed at a position facing the constricted portion 54A across the opening 55A are formed flat. Therefore, when the suture thread 10 is passed through the accommodation portion 55, the suture thread 10 can be smoothly moved into the accommodation portion 55 because the suture thread 10 is along the connection portion 53 and the arm portion 54.
  • the yarn fixing member including the narrowed portion as the retaining portion is not limited to the shape of the above-described yarn fixing member 52, and can be formed in various forms.
  • FIG. 15A and FIG. 15B are modifications based on a substantially hook-like shape like the thread stopper 30.
  • two arm portions 54 extend from the connection portion 31.
  • four arm portions 54 extend from the connection portion 31.
  • a substantially triangular accommodating portion 56 is formed by two adjacent arm portions in front view.
  • the distal end side of the arm portion 54 functions as a constriction portion that narrows the opening 56 ⁇ / b> A of the housing portion 56.
  • the protrusion 54B provided on the arm portion 54 functions as a constriction portion that narrows the opening 56A of the housing portion 56.
  • FIG. 16A to FIG. 16F show other modified examples of the thread fixing members each having a constricted portion.
  • the arm portion 57 may be formed in a curved shape like a thread fixing member 52A shown in FIG. 16A. In this case, a certain degree of freedom can be secured in the direction in which the force for deforming is applied, and the knot forming operation can be easily performed.
  • the arm portion 59 may be bent at a steep angle so that the accommodating portion 58 has a corner portion 58A.
  • 16C shows a yarn fixing member 52C including an arm portion 60 having an intermediate bending degree between the bending degree of the yarn fixing member 52A and the bending degree of the yarn fixing member 52B.
  • the yarn fastening members 52B and 52C are relatively easier to deform than the yarn fastening member 52A, and the knot forming operation can be easily performed.
  • an accommodation portion 61 that is formed in a substantially circular shape when viewed from the front may be provided as a thread stopper 52D shown in FIG. 16D.
  • a part of the arm portion 62 may be formed in a straight line like a thread fixing member 52E shown in FIG. 16E.
  • a narrowed portion 63A that narrows a portion that is not an opening in the housing portion may be provided in the arm portion 63 as in a thread fixing member 52F illustrated in FIG. 16F.
  • the opening 64A of the accommodating portion 64 can be widened, the suture thread 10 can be easily passed. Furthermore, it is possible to suitably prevent the stored suture 10 from being removed from the storage portion 64.
  • FIG. 17 is a perspective view showing the thread fixing member 72 of the ligating device 71 and its periphery.
  • the first arm part 74 ⁇ / b> A and the second arm part 74 ⁇ / b> B extending from the connection part 73 are formed in a curved shape in a front view of the thread fixing member 72.
  • the accommodating portion 75 formed between the first arm portion 74A and the second arm portion 74B has a shape that bends in the front view of the thread fixing member 72.
  • “bend” in the embodiment of the present invention means that at least a straight line connecting the deepest part along the shape of the accommodating part from the opening into which the suture thread enters and the opening in the accommodating part.
  • the deepest portion 75A of the accommodating portion 75 exists in the vicinity of the boundary between the first arm portion 74A and the second arm portion 74B.
  • a straight line connecting the deepest portion 75A and the opening 75B cannot be formed without contacting the first arm portion 74A and the second arm portion 74B. That is, the accommodation portion 75 of the thread fixing member 72 is bent in a front view of the thread fixing member 72.
  • the deepest part 75A can be easily obtained by the suture thread 10 being along the first arm part 74A or the second arm part 74B.
  • the suture thread 10 can be moved to the vicinity.
  • the movement in which the suture thread 10 tries to return to a straight line due to its elasticity or the like is generally a substantially linear movement in one direction. Therefore, the suture thread 10 inserted into the bent housing portion 75 contacts the first arm portion 74A or the second arm portion 74B regardless of the direction of movement. Therefore, it is substantially impossible to reach the opening 75B only by the above-described substantially linear movement. Therefore, the bent accommodating portion 75 has a function as a retaining portion due to its overall shape, and can suitably prevent the suture thread 10 from being detached from the thread retaining member 72 during the procedure.
  • a thread fixing member 72A shown in FIG. 19A is a modified example in which two accommodation portions having the same shape as the accommodation portion 75 are provided and are symmetrical with respect to the front view.
  • the thread fastening member 72A is formed in a substantially hook shape close to the thread fastening member 30 of the first embodiment, and is configured such that the suture thread that has passed through the housing portion is less likely to come out than the thread fastening member 30. Since the two accommodating portions are provided, the suture can be easily passed.
  • the thread fixing member 72A is provided with a punching hole 77 for forming the first arm portion 76A thinly. Therefore, it can be easily deformed at the same time as the accommodating portion is bent.
  • the direction of deformation has a relatively high degree of freedom, and the knot forming operation can be easily performed.
  • 19B and 19C are respectively provided with bending points at which the bending angle is approximately 90 degrees in the accommodating portion.
  • the remaining area of the accommodating portion is formed in a substantially linear shape. With this configuration, the operation of passing the suture thread 10 through the accommodating portion can be easily performed.
  • the thread stopper members 72D and 72E shown in FIG. 19D and FIG. 19E respectively have a relatively complicated shape containing a plurality of bending points.
  • the bending part in the accommodating part may be formed in a smooth curved shape as shown in FIG. 19D.
  • the bending part in a accommodating part may be formed so that it may have a corner
  • the bending part in a accommodating part may be formed combining the shape shown to FIG. 19D, and the shape shown to FIG. 19E.
  • the thread passed through the accommodation portion is more difficult to come off. Further, like the thread stopper 72F shown in FIG.
  • the outer shape of the thread stopper may not be bent, but only the housing portion may be bent.
  • the accommodating portion may be formed in a spiral shape when viewed from the front. In this case, similarly to the thread fixing members 72D and 72E, the suture thread that has passed through the housing portion is more difficult to come off.
  • FIG. 20A is an enlarged perspective view showing the thread fixing member 152 and its periphery of the ligating device 151 of the present embodiment.
  • the thread fixing member 152 has a substantially oval shape when viewed from the front.
  • the accommodating part 153 opened to the said substantially oval short-diameter direction is bent and formed in the substantially L shape.
  • the first arm portion 154 and the second arm portion 155 that define the shape of the housing portion 153 are larger than the dimension W1 in the width direction (direction perpendicular to the extending direction) of the housing portion 153.
  • a wide portion 156 having a large dimension is included.
  • the operation when the ligating device 151 is used is substantially the same as the ligating device of each of the above-described embodiments.
  • the suture 10 is positioned in the vicinity of the deepest portion 153A of the accommodating portion 153, and the accommodating portion 153 is deformed to tie the knot. kn is formed.
  • the knot forming operation can be performed easily and smoothly as in the above-described embodiments, and the knot can be formed stably.
  • the housing portion 153 is bent as in the third embodiment, and the bent state functions as a retaining portion.
  • the suture 10 is actually accommodated in a region on the deepest portion 153A side than the bent middle portion.
  • the inner wall 153C on the opening 153B side from the intermediate portion and opposed to the deepest portion 153A exclusively exhibits a retaining function, and functions as a substantial retaining part.
  • the first arm portion 154 and the second arm portion 155 have the wide portion 156, even if the dimension of the thread fixing member 152 is small, the operator can The entire stop member can be easily recognized as a lump, and the visibility can be maintained well.
  • the ligation device of the present embodiment is formed in a substantially oval shape when viewed from the front, it can be efficiently manufactured using a columnar material having a substantially oval cross-sectional shape. That is, the columnar material can be efficiently manufactured by slicing the columnar material in the radial direction after forming the shape of the accommodating portion over the length direction by wire discharge or the like.
  • the front view shape of the thread fixing member is a substantially oval shape
  • the front view shape may be a perfect circle, an ellipse, or a polygon. . Even if it is formed in such a shape, it is possible to ensure good visibility by providing a wide portion on the first arm portion or the second arm portion, and to efficiently use a columnar material having a cross-sectional shape corresponding to the front view shape. Can be manufactured well.
  • the width of the opening 153B of the housing portion 153 may be made wider than other portions so that the suture can be easily introduced into the housing portion. Such processing can also be easily performed by the above-described wire discharge or the like.
  • a protrusion 157 may be provided in the opening 153B. With such a configuration, the area when the thread fastening member is viewed from the side surface is increased, and visibility in a side view can be improved. Further, the position of the opening 153B can be easily grasped, and the operation of introducing the suture thread into the accommodating portion can be facilitated.
  • the connecting portions 158 may be provided at different positions.
  • the retaining portion is provided by forming at least a part of the thread securing member in a predetermined shape.
  • the retaining portion may be provided by attaching another member.
  • a substantially brush-like retaining portion 82 formed by attaching a plurality of bristle members 82A made of resin or the like to the inner surface of the accommodating portion 81.
  • a wheel 88 having a plurality of protrusions 88A is rotatably attached to the thread fixing member 85 shown in FIG. 23 at a position of the arm portion 86 located near the opening of the housing portion 87.
  • a stopper 89 that has a certain elasticity and interferes with the projection 88 ⁇ / b> A is attached to the arm portion 86.
  • the wheel 88 is configured so as to be able to rotate in one direction (indicated by an arrow in FIG. 23) for drawing the suture thread into the accommodating portion 87 and not in the opposite direction. Therefore, the wheel 88 inhibits the suture from moving in the direction in which the suture thread comes out of the accommodating portion 87. That is, in the yarn fixing member 85, the wheel 88 and the stopper 89 constitute a retaining portion.
  • FIG. 24 shows a thread fixing member 90 to which an elastic member 91 such as rubber is attached so as to close the housing portion 92 in a front view. Since the elastic member 91 is elastically deformed, the suture thread 10 can be passed through the accommodating portion 92 using forceps or the like. On the other hand, the elastic member 91 is not easily deformed because a sufficient force cannot be obtained only by the movement of the suture thread 10 to return to a straight line. Therefore, the elastic member 91 has a function as a retaining portion.
  • FIG. 25 shows a thread fixing member 95 in which a gel-like retaining material 97 having a certain viscosity is disposed in the accommodating portion 96. Since friction is generated between the suture thread 10 passed through the storage portion 96 and the retaining material 97, it is preferable to prevent the suture thread from slipping out of the storage portion 96.
  • This modification does not correspond to any of the above-described embodiments, but includes a retaining portion made of the retaining material 97.
  • the viscosity of the retaining material 97 is high, a resistance force is generated when the suture is drawn in the knot forming operation, which hinders the operation.
  • the retaining portion may not be provided integrally with the thread retaining member.
  • the insertion port 102 formed in the yarn fixing member 101 penetrates the yarn fixing member 101.
  • a retaining member 103 is connected and fixed to the second end portion 10B of the suture thread 10 inserted through the insertion port 102.
  • the retaining member 103 is formed such that at least a part of the dimension is larger than the width of the arm portion 104.
  • the shape of the retaining member 103 is not particularly limited as long as at least a part of the dimension is formed larger than the width of the arm portion 104. As shown in FIG. It may be formed in any shape.
  • the thread fixing member 101 and the suture thread 10 are slidably attached.
  • the suture thread and the thread fastening member may be attached as described above.
  • FIG. 27A to FIG. 27C are examples of a thread fixing member in which a protrusion is formed only in a part in the thickness direction.
  • FIG. 27B is a XXVb arrow view of FIG. 27A.
  • FIG. 27C is a view taken along the line XXVc in FIG. 27A.
  • the basic shape of the accommodation portion 111 of the thread fixing member 110 is a substantially linear shape in the front view of the yarn fastening member 110, but the protruding portion 112 protruding into the accommodation portion 111 is only partly in the thickness direction. Is formed.
  • FIG. 28A is an example of a thread fixing member provided with a narrowed portion in the thickness direction.
  • the end portion of the arm portion 116 of the thread fixing member 115 is curved so as to extend so as to overlap a part of the arm portion 116 extending from the connection portion 117 in the thickness direction.
  • the narrow gap between the overlapping arms 116 has a dimension that allows the suture 10 to pass therethrough.
  • the overlapped arm portion forms a constricted portion 118.
  • FIG. 29A to FIG. 29C are examples of the thread fixing member in which the accommodating portion is bent in the thickness direction.
  • FIG. 29B is a XXVIIb arrow view of FIG. 29A.
  • FIG. 29C is a XXVIIc arrow view of FIG. 29A.
  • the first arm portion 121 ⁇ / b> A and the second arm portion 121 ⁇ / b> B of the yarn fixing member 120 are formed to be curved in the thickness direction of the yarn fixing member 120.
  • the accommodating portion 122 between the first arm portion 121A and the second arm portion 121B is formed to be bent in the thickness direction.
  • the suture thread 10 passed through the housing portion 122 easily comes into contact with the side surfaces of the arm portions 121A and 121B that form the inner surface of the housing portion 122, and each arm portion.
  • Friction is easily generated between the side surfaces of 121A and 121B and the suture 10. As a result, the suture thread 10 is prevented from coming out of the accommodating portion 122.
  • the retaining portion formed in the thickness direction as described above may be combined with the configuration of each of the embodiments described above.
  • the ligating device may not include a suture needle. Even when a suture needle is not provided, it can be used for applications such as ligating without passing a suture through tissue.
  • a suture thread a general suture thread may be attached to the above-described thread stopper member immediately before the procedure. Accordingly, a single thread fixing member provided with a retaining portion may be distributed as a tissue ligation device.
  • the above-described concepts such as the protrusion, constriction, and bending are not mutually exclusive.
  • a part of the arm part forming the narrowed part can be regarded as a protruding part protruding into the accommodating part, and can be grasped in reverse.
  • the accommodating portion is bent by the protrusion. Therefore, the retaining portion is not a member that must be applied to any one of the above-described aspects, and there is no problem even if the retaining portion has a shape in which a plurality of elements are combined.
  • tissue ligation device capable of forming a knot more stably can be obtained.
  • Tissue Ligation Device 10 Suture 20 Suture Needle 30, 30A, 30B, 30C, 30D, 30E, 30F, 30G, 30H, 30I, 52, 52A, 52B, 52C, 52D, 52E, 52F, 72, 72A, 72B, 72C, 72D, 72E, 72F, 72G, 80, 85, 90, 95, 101, 110, 115, 120, 152 Thread fixing member 33, 43, 55, 56, 58, 61, 64, 75, 81, 87, 92, 97, 105, 111, 119, 122, 153 Housing part 34, 38, 39, 41, 44A, 44B, 44C, 112 Protrusion (retaining part) 54A, 63A, 118 Stenosis (retaining part) 82 Retaining part

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un dispositif de ligature tissulaire dans lequel une suture est attachée et utilisée pour la ligature tissulaire. Le dispositif de ligature tissulaire selon l'invention comprend : un élément (30) d'arrêt de filet ayant un réceptacle (33) dans lequel une partie d'une suture peut être introduite, le réceptacle étant attaché à la suture; et une partie de saillie (34) pour empêcher la suture ayant été introduite dans le réceptacle (33) d'être délogée du réceptacle (33).
PCT/JP2011/077498 2010-11-30 2011-11-29 Dispositif de ligature tissulaire WO2012073944A1 (fr)

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JP2010267776 2010-11-30
JP2010-267776 2010-11-30
JP2011-258684 2011-11-28
JP2011258684A JP2012130669A (ja) 2010-11-30 2011-11-28 組織結紮デバイス

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JP6413160B2 (ja) * 2013-05-09 2018-10-31 泉工医科工業株式会社 縫合糸係止部材及び縫合針セット
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WO2017029853A1 (fr) 2015-08-20 2017-02-23 オリンパス株式会社 Ensemble de suture, et système de suture
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